Skills in Cognitive behavioural Counselling and Psychotherapy ...2010453206 by sdfwerte


									   Skills in Cognitive
Behaviour Counselling &

  CHAPTER 6: Skills for working with
         emotions in CBT
       The nature and functions of
          (In as far as we have any real understanding of it whatsoever!)

• Emotion is a form of information about what is happening to us.
  It tells us that something in or around us may need attention. It
  often has evolutionary survival value.
• Emotions often seem to help us identify what we really need.
• Although emotions are often experienced as pure feelings, it is
  hard to make sense of them without attributing some element of
  cognitive appraisal and evaluation within them.
• There are ‘slow-track’ and ‘fast-track’ ways of processing
  emotions. There can be conflicts between the need for speed of
  processing and the need for accuracy in processing (e.g., ‘I am
  not quite sure if it is a lion or a tiger but I’m going to run
 Strategies for handling emotions
             in therapy
• Suppression of negative emotions often produces a
  ‘rebound’ effect.

• Therapeutically it is usually necessary to allow
  expression and encourage acceptance of emotions.

• It is helpful to distinguish between;
   – primary and secondary emotions
   – healthy and unhealthy emotions
   – instrumental and other emotions
 Primary and secondary emotions

• There are a few primary emotions, such as
  sadness, anger, fear and shame, that appear
  regularly as main issues in therapy.
• Secondary emotions may appear as
  emotions that ‘mask’ the primary emotions.
• A classic example is hurt and anger: anger
  may be a secondary emotion, the expression
  of which acts as a way of drawing attention
  away from the primary hurt.
  Healthy and unhealthy emotions
• HEALTHY EMOTIONS may be negative but tend to have a
  sense of freshness and newness. They are less related to ‘stuff’
  and seem to be clearly expressed and to push the client in a
  certain direction. They do not interfere with the client getting

• UNHEALTHY EMOTIONS are negative but they are old and
  familiar. They feel ‘stuck’ and are often hazily expressed. They
  show destructive effects, including inhibiting the client from
  getting proper help.

• INSTRUMENTAL EMOTIONS often function in an unhealthy
  way in that they be used in a covert way: e.g., crying as a way
  of eliciting sympathy.
      A process map for working with
             emotions in CBT
• IDENTIFYING the type of emotion.
• HEALTHY EMOTIONS: the therapist can encourage the client
  to accept these emotions and allow them to be processed with
  fairly minimal intervention – e.g., the AWARE strategy.
• PRIMARY UNHEALTHY EMOTIONS: consider emotional
  regulation, cognitive restructuring or ‘changing emotion with
  emotion’ (Greenberg, 2002).
  strategy is to try to bring to the surface the primary emotion and
  deal with that. Other strategies include trying to find out what
  need is met by the secondary or instrumental emotion, and to
  help the client find another way of meeting that need: e.g.,
  appropriate ways to seek people’s sympathy and time.
   Focusing as a way of processing
   healthy emotions (Gendlin, 1998)
1. Finding a still place.
2. Scanning the body for tension and signs of
  bodily held emotions.
3. Focusing on the emotions and allowing them to
4. Seeking to get a verbal handle on the emotion.
5. Allowing self to flow between feeling and verbal
  label, enabling emotions and meaning to
    Cognitive-emotional processing

• A variety of similar methods has been developed to
  allow for the more active processing or reprocessing of
  more negative emotions, especially those linked with
  PTSD. It is possible to see a generic form of cognitive-
  emotional processing that runs through all these
• CBT treatment of PTSD typically consists of some
  element of reprocessing the trauma story with
  appropriate emotions (Foa & Kozak (1986) on the ‘fear
  network’) plus other interventions to tackle other
  symptom areas such as avoidance and resultant
    Steps in cognitive-emotional
• Identify the negative emotion.
• Encourage the client to hold the emotion in
  open awareness.
• Allow the client to process the feeling and
  observe what new forms of feeling and
  meaning arise.
• Reflect on the shift in feeling and meaning.
• Stay with the shifts in feeling and meaning
  until they have fixed into a new meaning
How trauma processing works (1)

• Historical precedents with the work of Dr
  Rivers in the First World War (Barker, 1992).
• There is always the possibility of a new and
  more benign meaning emerging – the war
  after all is over, the accident is in the past.
• Has to be the right blend of new meaning and
  actual feeling – too intense emotion and/or
  post-accident pain can block processing and
  lead to ‘looping’ of the same trauma
How trauma processing works (2)

• Processing can ‘clear’ channels of negative
  meaning (similar to Freud’s and Breuer’s
  ‘chimney sweeping’ (Breuer et al., 1982)).
• Trauma memories are typically hazy –
  processing may regain lost details that help to
  shift the meaning of the trauma.
• There may be ‘layers of trauma’ – processing
  can help to feel them back – may uncover
  ‘nested’ previous traumas. (Can sometimes
  catch client and/or therapist unawares.)
               Imagery reprocessing
• Clients may retain sharp and disturbing images of early shameful
  experience that can re-emerge during periods of stress and trauma.
• It can be helpful to revisit the scenes of earlier trauma using
  imagery re-scripting.
• The client can be relaxed and taken back to the scene and
  encouraged to describe it in first-person, present-tense language
  (usually intensifies the memory and the feeling associated with it
  and thus allows some processing).
• Re-scripting can be used to a greater or lesser extent (according to
  client preference). New outcomes can be scripted or new elements
  can be introduced – these frequently result in positive meaning
  shifts and defusing of negative emotion.

• Sometimes emotions can be simply too intense to
  work through, process or focus on.
• We all at times need the capacity to soothe ourselves
  in the face of emotions that simply cannot be put
  aside or, for the moment, healed.
• Some psychoanalytic theorists, such as Kohut
  (1977), have suggested that we learn to soothe
  ourselves by seeing how we could be soothed by our
  parents or other significant people. Some people,
  however, sadly lack a soothing model and have to
  learn how to do it from scratch.
     Self-soothing and borderline
• Clients with borderline symptoms often have
  backgrounds of abuse and therefore usually do lack
  internal models of appropriate self-soothing.
• Self-soothing is a prime strategy, along with
  validation, in the treatment of borderline features
  using dialectic behaviour therapy (DBT, Linehan,
• Self-soothing in DBT is heavily dependent on
  mobilizing comforting sensory soothing using a
  predetermined client list of appropriate and favourite
  sensory modes that have worked for the client in the

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